THE GATE COACHVISION BEYOND PERCEPTION

28, Jia Sarai, Near IIT, New Delhi - 16; Ph: 9818652587, 9873452122, 011- 26529998

www.thegatecoach.com, www.thegatecoach.co.in

REGISTRATION FORM

Batch Starting Date:Branch: Date of Reg.:Student ID Code( To be filled by office only )

INSTRUCTION: USE BLACK INK PEN ONLY TO FILL UP THE FORM

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COURSE CODE

IAS IES

REGULAR WEEKEND

POSTAL ONLINE

CRASH COURSE

GATE PSU

SSC OTHERS

PROGRAM CODE

GENDER

CATAGORIES

CENTERS

1

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BRANCH CODE

Civil Engg.

General

New Delhi

Female

Chemical Engg.

OBC (NCL)

Chandigarh

Male

Electrical Engg.

ST

Computer Sc.

SC

AhmedabadOthers

Electronics Engg.

Mechanical Engg.Others

Instrumentation Engg.

STUDENT / CANDIDATE’S NAME (IN BLOCK LETTER ONLY)

MOBILE NUMBER PERSONAL DETAILS (IN CAPITAL LETTERS)

Father’s Name:....................................................................................

Father’s Contact No.:.........................................................................

Student’s e-mail ID:............................................................................

Phone ( with STD Code):..................................................................

Correspondence Address:...............................................................

....................................................................................................................

............................................................................PIN

Branch of Engg. UG/PG Name of College & City Passing Year % Marks

EDUCATIONAL DETAILS ( IN CAPITAL LETTERS)

( Student’s Signature )

4 HE AGATE ACOACH A

Total Fee: Registration fee : 3000/- Non-Refundable

Receipt No. Date Amount Paid Amount Due Due Date Received by

FOR OFFICE USE ONLY

Mode of Payment: Cash Demand Draft Bank

Rules and Instructions

(I) Every student is expected to maintain discipline inside and outside the classroom & institute. In case of violation of the rules & instructions the institute reserve the right to rusticate any student without any refund of fee. (II) All students are requested to bring their ID cards daily for attending classes & collecting study materials.

(III) Student is restricted to attain all class tests and test series otherwise penalty will be imposed by the institute.

(IV) It is mandatory to attach two photographs & copy of ID proof with the form at the time of admission. ( The name and photo of student may be published in the list of successful candidates in current or future sessions for promotion of institute).

(V) THE GATE COACH students are required to submit photocopy of their IES / GATE / PSU admit cards.

(VI) THE GATE COACH reserve the right to make any alternations in its / fees / faculty / venue of classes withoutprograms any prior notice to anybody. However all the changes will be informed to the students accordingly.

(VII) Student who will avail the facility to pay the fees in installments will be charged Rs. 1000/- per installment extra upto two installments and Rs. 1500/- extra per installment above two installments. The maximum duration is 30 days for the payment of next installment after the payment of prior.

PROOF OF IDENTITY (Submit self attested copy of ID proof)

Passport PAN Card

Election I-Card Driving license

College I-Card Others(Specify)

(Card holder: Candidate / Father)

Name:.............................................

Card No.........................................

Signature (Admin.)...............................

UNDERTAKING

I,..............................am applying for admission in .................................... program of the institute.

I certify that the information given by me is true to the best of my knowledge and belief. I understand that if any anything is found false / incorrect at any stage, my candidature / admission to the course shall be cancelled without any refund of fee.

I shall abide by all the rules and instructions of THE GATE COACH. I will have no objection on publication of my photo by the institute after my selection in the competitive exam and the institute will be entitled to use my photo and admission details for its advertisement purpose. I have enclosed the self attested copy of ID Proof / Address prof.

Date:

Place: Signature of candidate

I .......................................................guardian............................(relationship with the student) of.......................................................(student name)

hereby declared that I have completed all the formalities on behalf of the candidate. I have read and understood all the terms and conditions of

THE GATE COACH.

Signature of candidate Signature of Guardian

Signature of the Admin.: